{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:51:06Z","timestamp":1787316666020,"version":"build-2736575974"},"reference-count":93,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T00:00:00Z","timestamp":1699228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Dementia is a progressive decline in cognitive functions caused by an alteration in the pattern of neural network connections. There is an inability to create new neuronal connections, producing behavioral disorders. The most evident alteration in patients with neurodegenerative diseases is the alteration of sleep\u2013wake behavior. The aim of this study was to test the effect of two non-pharmacological interventions, therapeutic exercise (TE) and non-invasive neuromodulation through the NESA device (NN) on sleep quality, daytime sleepiness, and cognitive function of 30 patients diagnosed with dementia (non-invasive neuromodulation experimental group (NNG): mean \u00b1 SD, age: 71.6 \u00b1 7.43 years; therapeutic exercise experimental group (TEG) 75.2 \u00b1 8.63 years; control group (CG) 80.9 \u00b1 4.53 years). The variables were evaluated by means of the Pittsburg Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Mini-Cognitive Exam Test at four different times during the study: at baseline, after 2 months (after completion of the NNG), after 5 months (after completion of the TEG), and after 7 months (after 2 months of follow-up). Participants in the NNG and TEG presented significant improvements with respect to the CG, and in addition, the NNG generated greater relevant changes in the three variables with respect to the TEG (sleep quality (p = 0.972), daytime sleepiness (p = 0.026), and cognitive function (p = 0.127)). In conclusion, with greater effects in the NNG, both treatments were effective to improve daytime sleepiness, sleep quality, and cognitive function in the dementia population.<\/jats:p>","DOI":"10.3390\/ijerph20217027","type":"journal-article","created":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T13:24:53Z","timestamp":1699277093000},"page":"7027","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Improving Sleep Quality, Daytime Sleepiness, and Cognitive Function in Patients with Dementia by Therapeutic Exercise and NESA Neuromodulation: A Multicenter Clinical Trial"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3640-9065","authenticated-orcid":false,"given":"Esther","family":"Teruel-Hern\u00e1ndez","sequence":"first","affiliation":[{"name":"International School of Doctoral Studies, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1347-7759","authenticated-orcid":false,"given":"Jos\u00e9 Antonio","family":"L\u00f3pez-Pina","sequence":"additional","affiliation":[{"name":"Faculty of Psychology, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Souto-Camba","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Medicine and Biomedical Sciences, University of A Coru\u00f1a, 15006 A Coru\u00f1a, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6264-6312","authenticated-orcid":false,"given":"An\u00edbal","family":"B\u00e1ez-Su\u00e1rez","sequence":"additional","affiliation":[{"name":"Health Science Faculty, University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1015-847X","authenticated-orcid":false,"given":"Raquel","family":"Medina-Ram\u00edrez","sequence":"additional","affiliation":[{"name":"SocDig Research Group, University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"G\u00f3mez-Conesa","sequence":"additional","affiliation":[{"name":"Research Methods and Evaluation in the Social Sciences Research Group, Mare Nostrum Campus of International Excellence, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1016\/S0140-6736(05)67889-0","article-title":"Global prevalence of dementia: A Delphi consensus study","volume":"366","author":"Ferri","year":"2005","journal-title":"Lancet"},{"key":"ref_2","unstructured":"Alzheimer\u2019s Association (2020). Alzheimer\u2019s Disease Facts and Figures. Alzheimer\u2019s Dement., 16, 391\u2013460."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.amjmed.2018.01.022","article-title":"Dementia","volume":"131","author":"Gale","year":"2018","journal-title":"Am. J. Med."},{"key":"ref_4","first-page":"e12155","article-title":"Insight into the genetic etiology of Alzheimer\u2019s disease: A comprehensive review of the role of rare variants","volume":"13","author":"Hoogmartens","year":"2021","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2673","DOI":"10.1016\/S0140-6736(17)31363-6","article-title":"Dementia prevention, intervention, and care","volume":"390","author":"Livingston","year":"2017","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/S0140-6736(20)30367-6","article-title":"Dementia prevention, intervention, and care: 2020 report of the Lancet Commission","volume":"396","author":"Livingston","year":"2020","journal-title":"Lancet"},{"key":"ref_7","unstructured":"Kumar, A., Sidhu, J., Goyal, A., and Tsao, J.W. (2023). StatPearls [Internet], StatPearls Publishing."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.nrl.2016.02.016","article-title":"Prevalencia e incidencia de la enfermedad de Alzheimer en Europa: un metan\u00e1lisis","volume":"32","author":"Niu","year":"2017","journal-title":"Neurolog\u00eda"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/psyg.12069","article-title":"Sleep disturbances and dementia","volume":"15","author":"Cipriani","year":"2015","journal-title":"Psychogeriatrics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101472","DOI":"10.1016\/j.smrv.2021.101472","article-title":"Sleep and human cognitive development","volume":"57","author":"Mason","year":"2021","journal-title":"Sleep Med. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.jtherbio.2018.09.012","article-title":"Sleep environments and sleep physiology: A review","volume":"78","author":"Troynikov","year":"2018","journal-title":"J. Therm. Biol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.aprim.2019.01.009","article-title":"Delayed Sleep Phase Syndrome: A common sleep disorder in adolescents, with important quality of life repercussions","volume":"51","author":"Katz","year":"2019","journal-title":"Aten. Primaria"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.sleep.2004.12.005","article-title":"Sleep disturbance in mild to moderate Alzheimer\u2019s disease","volume":"6","author":"Moran","year":"2005","journal-title":"Sleep Med."},{"key":"ref_14","first-page":"CD009178","article-title":"Pharmacotherapies for sleep disturbances in dementia","volume":"11","author":"McCleery","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1111\/joim.12816","article-title":"Biomarkers for Alzheimer\u2019s disease: Current status and prospects for the future","volume":"284","author":"Blennow","year":"2018","journal-title":"J. Intern. Med."},{"key":"ref_16","unstructured":"GBD 2016 Dementia Collaborators (2019). Global, regional, and national burden of Alzheimer\u2019s disease and other dementias, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol., 18, 88\u2013106."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1007\/s00415-009-5196-1","article-title":"Delayed onset of the diurnal melatonin rise in patients with Huntington\u2019s disease","volume":"256","author":"Aziz","year":"2009","journal-title":"J. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S0531-5565(02)00198-5","article-title":"Melatonin rhythmicity: Effect of age and Alzheimer\u2019s disease","volume":"38","author":"Skene","year":"2003","journal-title":"Exp. Gerontol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1017\/S1041610209008886","article-title":"Bright light therapy for agitation in dementia: A randomized controlled trial","volume":"21","author":"Burns","year":"2009","journal-title":"Int. Psychogeriatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1017\/S1041610205001584","article-title":"Effect of morning bright light treatment for rest\u2013activity disruption in institutionalized patients with severe Alzheimer\u2019s disease","volume":"17","author":"Dowling","year":"2005","journal-title":"Int. Psychogeriatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1111\/j.1532-5415.2005.53252.x","article-title":"Nighttime Insomnia Treatment and Education for Alzheimer\u2019s Disease: A Randomized, Controlled Trial","volume":"53","author":"McCurry","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"102053","DOI":"10.1016\/j.aprim.2021.102053","article-title":"An\u00e1lisis del efecto a largo plazo de un programa de estimulaci\u00f3n cognitiva en mayores con deterioro cognitivo leve en Atenci\u00f3n Primaria: Ensayo controlado aleatorizado","volume":"53","year":"2021","journal-title":"Aten. Primaria"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.archger.2007.01.055","article-title":"Effectiveness of a cognitive rehabilitation program in mild dementia (MD) and mild cognitive impairment (MCI): A case control study","volume":"44","author":"Talassi","year":"2007","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.nrl.2015.12.003","article-title":"Musicoterapia y enfermedad de Alzheimer: Efectos cognitivos, psicol\u00f3gicos y conductuales","volume":"32","year":"2017","journal-title":"Neurolog\u00eda."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s13195-023-01214-9","article-title":"The effect of music therapy on cognitive functions in patients with Alzheimer\u2019s disease: A systematic review of randomized controlled trials","volume":"15","author":"Bleibel","year":"2023","journal-title":"Alzheimer\u2019s Res. Ther."},{"key":"ref_26","first-page":"2","article-title":"CSF biomarkers of neuroinflammation in distinct forms and subtypes of neurodegenerative dementia","volume":"12","author":"Steinacker","year":"2019","journal-title":"Alzheimer\u2019s Res. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1016\/S0278-6915(02)00096-0","article-title":"Effects of caffeine on human behavior","volume":"40","author":"Smith","year":"2002","journal-title":"Food Chem. Toxicol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.regg.2019.07.003","article-title":"Efectos del ejercicio f\u00edsico sobre la calidad del sue\u00f1o, insomnio y somnolencia diurna en personas mayores. Revisi\u00f3n de la literatura","volume":"55","year":"2020","journal-title":"Rev. Esp. Geriatr. Gerontol."},{"key":"ref_29","first-page":"404","article-title":"Revisiting the cholinergic hypothesis of behavioral and psychological symptoms in dementia of the Alzheimer\u2019s type","volume":"10","author":"Pinto","year":"2011","journal-title":"Ageing Res. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/ggi.12082","article-title":"Effect of a multimodal exercise program on sleep disturbances and instrumental activities of daily living performance on Parkinson\u2019s and Alzheimer\u2019s disease patients","volume":"14","author":"Nascimento","year":"2014","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jocn.2021.01.042","article-title":"The impact of exercise on sleep in people with Parkinson\u2019s disease a scoping review","volume":"86","author":"Ivy","year":"2021","journal-title":"J. Clin. Neurosci."},{"key":"ref_32","first-page":"1","article-title":"Rehabilitation in Sleep, Pain, and Bladder Symptoms of NESA Neuromodulation Application in Multiple Sclerosis Patients: A Innovative Treatment","volume":"15","year":"2023","journal-title":"CPQ Med."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"B\u00e1ez-Su\u00e1rez, A., Padr\u00f3n-Rodr\u00edguez, I., Castellano-Moreno, E., Gonz\u00e1lez-Gonz\u00e1lez, E., Quintana-Montesdeoca, M.P., and Medina-Ramirez, R.I. (2023). Application of non-invasive neuromodulation in children with neurodevelopmental disorders to improve their sleep quality and constipation. BMC Pediatr., 23.","DOI":"10.1186\/s12887-023-04307-4"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1176\/ajp.139.9.1136","article-title":"The Global Deterioration Scale for assessment of primary degenerative dementia","volume":"139","author":"Reisberg","year":"1982","journal-title":"Am. J. Psychiatry"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"227","DOI":"10.4067\/S0717-95022017000100037","article-title":"T\u00e9cnicas de Muestreo sobre una Poblaci\u00f3n a Estudio Sampling Techniques on a Population Study","volume":"35","author":"Otzen","year":"2017","journal-title":"Int. J. Morphol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1046\/j.1532-5415.2003.51466.x","article-title":"Training Caregivers to Change the Sleep Hygiene Practices of Patients with Dementia: The NITE-AD Project","volume":"51","author":"McCurry","year":"2003","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1177\/07487304211044301","article-title":"Circadian Rhythms, Disease and Chronotherapy","volume":"36","author":"Lee","year":"2021","journal-title":"J. Biol. Rhythm."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/j.1479-8425.2006.00235.x","article-title":"Epidemiology of exercise and sleep","volume":"4","author":"Youngstedt","year":"2006","journal-title":"Sleep Biol. Rhythm."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.aprim.2018.09.010","article-title":"Efecto del ejercicio f\u00edsico en la enfermedad de Alzheimer. Una revisi\u00f3n sistem\u00e1tica","volume":"52","year":"2020","journal-title":"Aten. Primaria"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.nrl.2014.11.001","article-title":"Beneficios de la musicoterapia en los trastornos de conducta en sujetos diagnosticados con demencia: una revisi\u00f3n sistem\u00e1tica","volume":"32","year":"2017","journal-title":"Neurologia"},{"key":"ref_41","first-page":"1","article-title":"Nesa Non-Invasive Neuromodulation; A New Frontier of Treatment of the Autonomous Nervous System in Physiotherapy","volume":"5","year":"2021","journal-title":"CPQ Orthopaedics."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S232","DOI":"10.1016\/j.eurpsy.2016.01.578","article-title":"Superficial neurostimulation application, alpha rhythm and clinical effects","volume":"33","author":"Rico","year":"2016","journal-title":"Eur. Psychiatry"},{"key":"ref_43","unstructured":"Molina, F., Medina-Ram\u00edrez, R., and B\u00e1ez A \u00c1lamo-Arce, D.D. (2020, January 11). Recuperaci\u00f3n exitosa de un S\u00edndrome Regional Complejo a trav\u00e9s de la electroterapia de neuromodulaci\u00f3n del Sistema Nervioso Aut\u00f3nomo. Proceedings of the 58\u00b0 Congreso SERMEF, Mallorca, Spain. Available online: http:\/\/hdl.handle.net\/10553\/114084."},{"key":"ref_44","unstructured":"Lled\u00f3-Amat, M., Sancho-Franc\u00e9s, A., \u00c1lamo Arce, D.D., and Medina Ram\u00edrez, R.I. (2021, January 26). Tratamiento de la neuralgia del trig\u00e9mino con Neuromodulaci\u00f3n no invasiva NESA: A prop\u00f3sito de un caso. Proceedings of the Congreso Nacional de Fisioterapia de la UMH, Elche, Spain."},{"key":"ref_45","unstructured":"Lled\u00f3-Amat, M., Medina-Ram\u00edrez, R., \u00c1lamo-Arce, D.D., and Arteaga-Ortiz, R. (2021, January 26). Efectos de la Neuromodulaci\u00f3n no invasiva NESA en el tratamiento de secuelas de Ictus: A prop\u00f3sito de un caso. Proceedings of the Congreso Nacional de Fisioterapia de la UMH, Elche, Spain."},{"key":"ref_46","unstructured":"Contreras, M., and Medina-Ram\u00edrez, R.I. (2021, January 26). Caso cl\u00ednico de neuromodulaci\u00f3n superficial aplicada (NESA) en pacientes con Esclerosis M\u00faltiple. Proceedings of the Congreso de Fisioterapia Nacional UMH, Elche, Spain."},{"key":"ref_47","unstructured":"Medina-Ram\u00edrez, R.I., Molina, F., Medina-Ram\u00edrez, R., B\u00e1ez, A., and \u00c1lamo-Arce, D.D. (2020, January 27). Tecnolog\u00eda NESA. Un nuevo tratamiento revolucionario en fisioterapia. Macaronesian Researcher\u2019s night. Proceedings of the Horizonte 2020 Congress, Las Palmas, Spain."},{"key":"ref_48","first-page":"834","article-title":"Neuropathology of Dementia Disorders","volume":"28","author":"Schneider","year":"2022","journal-title":"Continuum"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Sharma, A., Angnes, L., Sattarahmady, N., Negahdary, M., and Heli, H. (2023). Electrochemical Immunosensors Developed for Amyloid-Beta and Tau Proteins, Leading Biomarkers of Alzheimer\u2019s Disease. Biosensors, 13.","DOI":"10.3390\/bios13070742"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1007\/s00415-022-11490-4","article-title":"Use of remote monitoring and integrated platform for the evaluation of sleep quality in adult-onset idiopathic cervical dystonia","volume":"270","author":"Bailey","year":"2023","journal-title":"J. Neurol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1378\/chest.103.1.30","article-title":"Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale","volume":"103","author":"Johns","year":"1993","journal-title":"Chest"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"240","DOI":"10.20344\/amp.6889","article-title":"Mini-Mental State Examination: Avalia\u00e7\u00e3o dos Novos Dados Normativos no Rastreio e Diagn\u00f3stico do D\u00e9fice Cognitivo","volume":"29","author":"Santana","year":"2016","journal-title":"Acta Med. Port."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1192\/bjp.149.6.698","article-title":"CAMDEX: A Standardised Instrument for the Diagnosis of Mental Disorder in the Elderly with Special Reference to the Early Detection of Dementia","volume":"149","author":"Roth","year":"1986","journal-title":"Br. J. Psychiatry"},{"key":"ref_55","first-page":"337","article-title":"Validity of the Cognitive Mini-Exam of Lobo et al. for the detection of dementia-associated cognitive deterioration","volume":"15","author":"Calero","year":"2000","journal-title":"Neurologia"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.regg.2010.09.006","article-title":"Evaluaci\u00f3n breve del estado cognitivo de la demencia en estadios avanzados: Resultados preliminares de la validaci\u00f3n espa\u00f1ola del Severe Mini-Mental State Examination","volume":"46","author":"Buiza","year":"2011","journal-title":"Rev. Esp. Geriatr. Gerontol."},{"key":"ref_57","unstructured":"Asociaci\u00f3n M\u00e9dica Mundial (2013). Declaraci\u00f3n de Helsinki de la Asociaci\u00f3n M\u00e9dica Mundial: Principios \u00e9ticos para la investigaci\u00f3n m\u00e9dica en seres humanos. JAMA, 310, 2191\u20132194."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s12957-023-02895-0","article-title":"Improvement of sleep quality in isolated metastatic patients with spinal cord compression after surgery","volume":"21","author":"Cao","year":"2023","journal-title":"World J. Surg. Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.5664\/jcsm.8690","article-title":"Low repeatability of the Epworth Sleepiness Scale and the need to redefine the minimal clinically important difference","volume":"16","author":"Hunasikatti","year":"2020","journal-title":"J. Clin. Sleep Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.trci.2019.06.005","article-title":"Disease severity and minimal clinically important differences in clinical outcome assessments for Alzheimer\u2019s disease clinical trials","volume":"5","author":"Andrews","year":"2019","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e13229","DOI":"10.1111\/jsr.13229","article-title":"Pharmacological and non-pharmacological interventions to enhance sleep in mild cognitive impairment and mild Alzheimer\u2019s disease: A systematic review","volume":"30","author":"Blackman","year":"2021","journal-title":"J. Sleep Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s41999-018-0068-9","article-title":"A randomized placebo-controlled trial evaluating the effect of melatonin on sleep quality in patients with mild\u2013moderate dementia","volume":"9","year":"2018","journal-title":"Eur. Geriatr. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/j.jagp.2013.12.174","article-title":"Trazodone Improves Sleep Parameters in Alzheimer Disease Patients: A Randomized, Double-Blind, and Placebo-Controlled Study","volume":"22","author":"Camargos","year":"2014","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e13328","DOI":"10.1111\/jsr.13328","article-title":"Pilot evaluation of a consumer wearable device to assess sleep in a clinical polysomnography trial of suvorexant for treating insomnia in patients with Alzheimer\u2019s disease","volume":"30","author":"Svetnik","year":"2021","journal-title":"J. Sleep Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1002\/alz.12035","article-title":"Polysomnographic assessment of suvorexant in patients with probable Alzheimer\u2019s disease dementia and insomnia: A randomized trial","volume":"16","author":"Herring","year":"2020","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1002\/acn3.796","article-title":"Acoustic enhancement of sleep slow oscillations in mild cognitive impairment","volume":"6","author":"Papalambros","year":"2019","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"7111","DOI":"10.1523\/JNEUROSCI.0260-17.2017","article-title":"Promoting Sleep Oscillations and Their Functional Coupling by Transcranial Stimulation Enhances Memory Consolidation in Mild Cognitive Impairment","volume":"37","author":"Ladenbauer","year":"2017","journal-title":"J. Neurosci."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s12013-013-9529-4","article-title":"Efficacy of Repetitive Transcranial Magnetic Stimulation in the Treatment of Patients with Chronic Primary Insomnia","volume":"67","author":"Jiang","year":"2013","journal-title":"Cell Biochem. Biophys."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1111\/jsr.12301","article-title":"Slow oscillating transcranial direct current stimulation during sleep has a sleep-stabilizing effect in chronic insomnia: A pilot study","volume":"24","author":"Saebipour","year":"2015","journal-title":"J. Sleep Res."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1032020","DOI":"10.3389\/fphys.2022.1032020","article-title":"Recovery of the physiological status in professional basketball players using NESA neuromodulation treatment during different types of microcycles in season: A preliminary randomized clinical trial","volume":"13","author":"Font","year":"2022","journal-title":"Front. Physiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1080\/15402002.2018.1518223","article-title":"\u201cSleep Well, Think Well\u201d Group Program for Mild Cognitive Impairment: A Randomized Controlled Pilot Study","volume":"17","author":"Naismith","year":"2019","journal-title":"Behav. Sleep Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"103706","DOI":"10.1016\/j.ijnurstu.2020.103706","article-title":"Effects and mediating mechanisms of a structured limbs-exercise program on general cognitive function in older adults with mild cognitive impairment: A randomized controlled trial","volume":"110","author":"Wang","year":"2020","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Suzuki, T., Shimada, H., Makizako, H., Doi, T., Yoshida, D., Ito, K., Shimokata, H., Washimi, Y., Endo, H., and Kato, T. (2013). A Randomized Controlled Trial of Multicomponent Exercise in Older Adults with Mild Cognitive Impairment. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0061483"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Jiang, H., Chen, S., Wang, L., and Liu, X. (2019). An Investigation of Limbs Exercise as a Treatment in Improving the Psychomotor Speed in Older Adults with Mild Cognitive Impairment. Brain Sci., 9.","DOI":"10.3390\/brainsci9100277"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Papatsimpas, V., Vrouva, S., Papadopoulou, M., Papathanasiou, G., and Bakalidou, D. (2023). The Effects of Aerobic and Resistance Exercises on the Cognitive and Physical Function of Persons with Mild Dementia: A Randomized Controlled Trial Protocol. Healthcare, 11.","DOI":"10.3390\/healthcare11050677"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"E15","DOI":"10.1519\/JPT.0000000000000191","article-title":"Effect of Exercise on Cognition, Conditioning, Muscle Endurance, and Balance in Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial","volume":"42","author":"Langoni","year":"2019","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e1298","DOI":"10.1212\/WNL.0000000000005290","article-title":"Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women","volume":"90","author":"Johansson","year":"2018","journal-title":"Neurology"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1860","DOI":"10.1016\/j.neurobiolaging.2015.02.023","article-title":"Transcutaneous vagus nerve stimulation boosts associative memory in older individuals","volume":"36","author":"Jacobs","year":"2015","journal-title":"Neurobiol. Aging"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s10286-019-00604-0","article-title":"Inspiratory- and expiratory-gated transcutaneous vagus nerve stimulation have different effects on heart rate in healthy subjects: Preliminary results","volume":"31","author":"Paleczny","year":"2021","journal-title":"Clin. Auton. Res."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s11920-015-0592-y","article-title":"Neuromodulation Therapies for Geriatric Depression","volume":"17","author":"Ho","year":"2015","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.psc.2013.08.007","article-title":"The Role of Electroconvulsive and Neuromodulation Therapies in the Treatment of Geriatric Depression","volume":"36","author":"Hermida","year":"2013","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"102900","DOI":"10.1016\/j.autneu.2021.102900","article-title":"Current challenges in reliably targeting the noradrenergic locus coeruleus using transcutaneous auricular vagus nerve stimulation (taVNS)","volume":"236","author":"Ludwig","year":"2021","journal-title":"Auton. Neurosci."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1038\/s41467-021-21730-2","article-title":"Graded recruitment of pupil-linked neuromodulation by parametric stimulation of the vagus nerve","volume":"12","author":"Mridha","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"112975","DOI":"10.1016\/j.expneurol.2019.112975","article-title":"Norepinephrine and serotonin are required for vagus nerve stimulation directed cortical plasticity","volume":"320","author":"Hulsey","year":"2019","journal-title":"Exp. Neurol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1016\/j.cub.2021.02.049","article-title":"Vagus nerve stimulation induces widespread cortical and behavioral activation","volume":"31","author":"Collins","year":"2021","journal-title":"Curr. Biol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1523\/JNEUROSCI.1361-20.2020","article-title":"Transcutaneous Vagus Nerve Stimulation in Humans Induces Pupil Dilation and Attenuates Alpha Oscillations","volume":"41","author":"Sharon","year":"2021","journal-title":"J. Neurosci."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.brs.2020.03.011","article-title":"Stimulus frequency modulates brainstem response to respiratory-gated transcutaneous auricular vagus nerve stimulation","volume":"13","author":"Sclocco","year":"2020","journal-title":"Brain Stimul."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.cortex.2021.04.004","article-title":"Effects of transcutaneous vagus nerve stimulation (tVNS) on beta and gamma brain oscillations","volume":"140","author":"Keute","year":"2021","journal-title":"Cortex"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"e614","DOI":"10.1093\/geront\/gnab168","article-title":"Light Intervention Effects on Circadian Activity Rhythm Parameters and Nighttime Sleep in Dementia Assessed by Wrist Actigraphy: A Systematic Review and Meta-Analysis","volume":"62","author":"Canazei","year":"2022","journal-title":"Gerontologist."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"102630","DOI":"10.1016\/j.artmed.2023.102630","article-title":"Insight into ADHD diagnosis with deep learning on Actimetry: Quantitative interpretation of occlusion maps in age and gender subgroups","volume":"143","year":"2023","journal-title":"Artif. Intell. Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1177\/0004867420976853","article-title":"Heart rate variability in patients with dementia or neurocognitive disorders: A systematic review and meta-analysis","volume":"56","author":"Cheng","year":"2022","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"8123","DOI":"10.1038\/s41598-021-87489-0","article-title":"Accuracy of heart rate variability estimated with reflective wrist-PPG in elderly vascular patients","volume":"11","author":"Mai","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1088\/1361-6579\/aa9047","article-title":"Estimation of sleep stages in a healthy adult population from optical plethysmography and accelerometer signals","volume":"38","author":"Beattie","year":"2017","journal-title":"Physiol. Meas."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/21\/7027\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:18:28Z","timestamp":1760131108000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/21\/7027"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,6]]},"references-count":93,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["ijerph20217027"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20217027","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,6]]}}}